Working paper 00/027 - Abstract

Does Competition Between Hospitals Improve the Quality of Care? Hospital Death Rates and the NHS Internal Market

Carol Propper, Simon Burgess and Katherine Green

Payer driven competition has been widely advocated as a means of increasing efficiency in health care markets. The 1990s reforms to the UK health service followed this path. We examine whether competition led to better outcomes for patients, as measured by death rates after treatment following heart attacks. Using data that until 1999 was not publicly available in any form on hospital level death rates, we find that the relationship between competition and quality of care appears to be negative. Greater competition is associated with higher death rates, controlling for patient mix and other observed characteristics of the hospital and the catchment area for its patients. However, the estimated impact of competition is small.

Published in Journal of Public Economics 88 (708) 1247-1272 (July 2004)

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